The MRI

Like endoscopy, the MRI is a dreaded place for the anesthesiologist because it is a remote out-of-OR location. I had to provide general anesthesia to a patient who required an MRI but could not tolerate the positioning and duration. I went down to the depths of the hospital, uncertain of what I'd find. MRI is a tricky business because the strong magnetic field it creates limits the equipment that can accompany patients. Before entering the room, I emptied my pockets and even took off my badge. The MRI-compatible anesthesia machine and monitors were old and confusing.

We had a patient with a difficult airway and we were miles away from any other anesthesiologist. Although we initially tried an asleep fiberoptic intubation, we could not see the vocal cords, so instead, we did a direct laryngoscopy and managed to intubate the old fashioned way. While we were struggling to get a way to help breathe for the patient, I was terrified. In the operating room, we have so many more resources - other anesthesiologists, fancy equipment, nurses and anesthesia techs to help. But in MRI, we had only what we brought (luckily, we had anticipated this and brought the difficult airway cart).

The scan itself was a little scary as well. The patent's blood pressures required constant vasopressor support so I kept on popping in to give more medication. I had heard this from patients, but MRIs are loud and the noises they make are unpredictable. During the scan, we didn't have access to the patient's IV site, airway, or body (if we needed to start chest compressions). It made me realize that environment plays a lot in determining the difficulty of our jobs.

Image is in the public domain, from nihlbi.nih.gov.